Fractional Flow Reserve Versus Instantaneous Wave‐Free Ratio in Assessment of Lesion Hemodynamic Significance and Explanation of their Discrepancies. International, Multicenter and Prospective Trial: The FiGARO Study
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Published:2022-05-03
Issue:9
Volume:11
Page:
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ISSN:2047-9980
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Container-title:Journal of the American Heart Association
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language:en
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Short-container-title:JAHA
Author:
Kovarnik Tomas1ORCID, Hitoshi Matsuo2ORCID, Kral Ales1, Jerabek Stepan1, Zemanek David1, Kawase Yoshiaki2, Omori Hiroyuki2, Tanigaki Toru2, Pudil Jan1, Vodzinska Alexandra3, Branny Marian4, Stipal Roman5, Kala Petr5, Mrozek Jan4, Porzer Martin4, Grezl Tomas4, Novobilsky Kamil6, Mendiz Oscar7ORCID, Kopriva Karel8, Mates Martin8ORCID, Chval Martin9, Chen Zhi10, Martasek Pavel11, Linhart Ales1, Kovarnik Tomas, Kral Ales, Jerabek Stepan, Zemanek David, Pudil Jan, Humhal Jiri, Gorican Karel, Padour Michael, Šimek Stanislav, Belohlavek Jan, Rob Daniel, Hronova Michaela, Kral Ales, Hitoshi Matsuo, Kawase Yoshiaki, Omori Hiroyuki, Tanigaki Toru, Vodzinska Alexandra, Cerny Jindrich, Indrak Jan, Hudec Miroslav, Branny Marian, Mrozek Jan, Porzer Martin, Grezl Tomas, Stipal Roman, Kala Petr, Kanovsky Jan, Bocek Otakar, Poloczek Martin, Jerabek Petr, Novobilsky Kamil, Kolomaznik Tomas, Mendiz Oscar, Kopriva Karel, Mates Martin, Holy Frantisek, Chval Martin, Chen Zhi, Martasek Pavel, Kralik Lubomir
Affiliation:
1. 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic 2. Gifu Heart Center Gifu Japan 3. Cardiology Department of Trinec Podlesi Hospital Trinec Czech Republic 4. Cardiovascular Department University Hospital Ostrava Ostrava Czech Republic 5. Department of Internal Medicine and Cardiology University HospitalFaculty of MedicineMasaryk University Brno Brno Czech Republic 6. Cardiology Department Municipal Hospital Ostrava Ostrava Czech Republic 7. Fundacion Favaloro Buenos Aires Argentina 8. Cardiology Department Homolka Hospital Prague Czech Republic 9. Institute for Research and Development of Education Faculty of Education Charles University Prague Czech Republic 10. Department of Electrical & Computer Engineering Iowa Institute for Biomedical ImagingThe University of Iowa IA 11. Department of Paediatrics and Inherited Metabolic Disorders First Faculty of Medicine Charles UniversityGeneral University Hospital Prague Czech Republic
Abstract
Background
The FiGARO (FFR versus iFR in Assessment of Hemodynamic Lesion Significance, and an Explanation of Their Discrepancies) trial is a prospective registry searching for predictors of fractional flow reserve/instantaneous wave‐free ratio (FFR/iFR) discrepancy.
Methods and Results
FFR/iFR were analyzed using a Verrata wire, and coronary flow reserve was analyzed using a Combomap machine (both Philips‐Volcano). The risk polymorphisms for endothelial nitric oxide synthase and for heme oxygenase‐1 were analyzed. In total, 1884 FFR/iFR measurements from 1564 patients were included. The FFR/iFR discrepancy occurred in 393 measurements (20.9%): FFRp (positive)/iFRn (negative) type (264 lesions, 14.0%) and FFRn/iFRp (129 lesions, 6.8%) type. Coronary flow reserve was measured in 343 lesions, correlating better with iFR (R=0.56,
P
<0.0001) than FFR (R=0.36,
P
<0.0001). The coronary flow reserve value in FFRp/iFRn lesions (2.24±0.7) was significantly higher compared with both FFRp/iFRp (1.39±0.36), and FFRn/iFRn lesions (1.8±0.64,
P
<0.0001). Multivariable logistic regression analysis confirmed (1) sex, age, and lesion location in the right coronary artery as predictors for FFRp/iFRn discrepancy; and (2) hemoglobin level, smoking, and renal insufficiency as predictors for FFRn/iFRp discrepancy. The FFRn/iFRp type of discrepancy was significantly more frequent in patients with both risk types of polymorphisms (endothelial nitric oxide synthase
r
+heme oxygenase‐1
r
): 8 patients (24.2%) compared with FFRp/iFRn type of discrepancy: 2 patients (5.9%),
P
=0.03.
Conclusions
Predictors for FFRp/iFRn discrepancy were sex, age, and location in the right coronary artery. Predictors for FFRn/iFRp were hemoglobin level, smoking, and renal insufficiency. The risk type of polymorphism in endothelial nitric oxide synthase and heme oxygenase‐1 genes was more frequently found in patients with FFRn/iFRp type of discrepancy.
Registration
URL:
https://clinicaltrials.gov
; Unique identifier: NCT03033810.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
10 articles.
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